A Cross-Sectional Study of Overtreatment and Deintensification of Antidiabetic and Antihypertensive Medications in Diabetes Mellitus: The TEMD Overtreatment Study

Alper Sonmez, Ilker Tasci, Ibrahim Demirci, Cem Haymana, Cem Barcin, Hasan Aydin, Sevki Cetinkalp, Feyza Yener Ozturk, Kamile Gul, Tevfik Sabuncu, Ilhan Satman, Fahri Bayram, TEMD Study Group, Sibel Guldiken, Semra Ayturk, Murat Yilmaz, Mehmet Asik, Nevin Dinccag, Ilhan Satman, Ramazan Cakmak, Fulya Turker, Cemile Idiz, Hulya Hacisahinogullari, Elif Bagdemir, Busra Yildiz, Volkan Demirhan Yumuk, Ozlem Haliloglu, Serpil Salman, Seda Sancak, Levent Ozsari, Eylem Cagiltay, Oguzhan Deyneli, Eren Imre, Sait Gonen, S Nur Boysan, Yuksel Altuntas, Feyza Yener Ozturk, Meral Mert, Hamide Piskinpasa, Hasan Aydin, Sazi Imamoglu, Canan Ersoy, Ozen Oz Gul, Sinem Kucuksarac Kiyici, Berrin Cetinarslan, Alev Selek, Teoman Dogru, Ali Kirik, Nur Kebapci, Belgin Efe, Ahmet Kaya, Ilker Cordan, Suleyman Baldane, Cem Onur Kirac, Alper Sonmez, Cem Haymana, Ibrahim Demirci, Zehra Capa, Cem Barcın, Mustafa Cesur, Ilhan Yetkin, Demet Corapcioglu, Sule Canlar, Okan Bulent Yildiz, Suleyman Nahit Sendur, Bekir Cakir, Didem Ozdemir, Ahmet Corakci, Mustafa Kutlu, Neslihan Bascil Tutuncu, Yusuf Bozkus, Erman Cakal, Berrin Demirbas, Sibel Ertek, Mustafa Altay, Murat Dagdeviren, Oguzhan Sıtkı Dizdar, Fahri Bayram, Amir Hassein Abedi, Sevki Cetinkalp, Hatice Ozisik, Guzide Gonca Oruk, Serkan Yener, Basak Ozgen Saydam, Engin Guney, Mustafa Unubol, Guzin Fidan Yaylali, Senay Topsakal, Zeliha Hekimsoy, Gulhan Akbaba, Ibrahim Aslan, Mustafa Kemal Balci, Sefika Dalkiran, Esen Akbay, Kamile Gul, Eren Gurkan, Kemal Agbaht, Muge Ozsan Yilmaz, Emre Bozkirli, B Tamer Tetiker, Seher Cetinkaya Altuntas, Aysegul Atmaca, Elif Tutku Durmus, Turkan Mete, Faruk Kutluturk, Ferit Kerim Kucukler, Oguz Dikbas, Safak Akin, Irfan Nuhoglu, Halil Onder Ersoz, Taner Bayraktaroglu, Ayse Kargılı Carlioglu, Pınar Sisman, İbrahim Sahin, Sedat Cetin, İlyas Capoglu, Emin Murat Akbas, Rıfkı Ucler, Tevfik Sabuncu, Mehmet Ali Eren, Alpaslan Kemal Tuzcu, Zafer Pekkolay, Mesut Ozkaya, Mustafa Araz, Alper Sonmez, Ilker Tasci, Ibrahim Demirci, Cem Haymana, Cem Barcin, Hasan Aydin, Sevki Cetinkalp, Feyza Yener Ozturk, Kamile Gul, Tevfik Sabuncu, Ilhan Satman, Fahri Bayram, TEMD Study Group, Sibel Guldiken, Semra Ayturk, Murat Yilmaz, Mehmet Asik, Nevin Dinccag, Ilhan Satman, Ramazan Cakmak, Fulya Turker, Cemile Idiz, Hulya Hacisahinogullari, Elif Bagdemir, Busra Yildiz, Volkan Demirhan Yumuk, Ozlem Haliloglu, Serpil Salman, Seda Sancak, Levent Ozsari, Eylem Cagiltay, Oguzhan Deyneli, Eren Imre, Sait Gonen, S Nur Boysan, Yuksel Altuntas, Feyza Yener Ozturk, Meral Mert, Hamide Piskinpasa, Hasan Aydin, Sazi Imamoglu, Canan Ersoy, Ozen Oz Gul, Sinem Kucuksarac Kiyici, Berrin Cetinarslan, Alev Selek, Teoman Dogru, Ali Kirik, Nur Kebapci, Belgin Efe, Ahmet Kaya, Ilker Cordan, Suleyman Baldane, Cem Onur Kirac, Alper Sonmez, Cem Haymana, Ibrahim Demirci, Zehra Capa, Cem Barcın, Mustafa Cesur, Ilhan Yetkin, Demet Corapcioglu, Sule Canlar, Okan Bulent Yildiz, Suleyman Nahit Sendur, Bekir Cakir, Didem Ozdemir, Ahmet Corakci, Mustafa Kutlu, Neslihan Bascil Tutuncu, Yusuf Bozkus, Erman Cakal, Berrin Demirbas, Sibel Ertek, Mustafa Altay, Murat Dagdeviren, Oguzhan Sıtkı Dizdar, Fahri Bayram, Amir Hassein Abedi, Sevki Cetinkalp, Hatice Ozisik, Guzide Gonca Oruk, Serkan Yener, Basak Ozgen Saydam, Engin Guney, Mustafa Unubol, Guzin Fidan Yaylali, Senay Topsakal, Zeliha Hekimsoy, Gulhan Akbaba, Ibrahim Aslan, Mustafa Kemal Balci, Sefika Dalkiran, Esen Akbay, Kamile Gul, Eren Gurkan, Kemal Agbaht, Muge Ozsan Yilmaz, Emre Bozkirli, B Tamer Tetiker, Seher Cetinkaya Altuntas, Aysegul Atmaca, Elif Tutku Durmus, Turkan Mete, Faruk Kutluturk, Ferit Kerim Kucukler, Oguz Dikbas, Safak Akin, Irfan Nuhoglu, Halil Onder Ersoz, Taner Bayraktaroglu, Ayse Kargılı Carlioglu, Pınar Sisman, İbrahim Sahin, Sedat Cetin, İlyas Capoglu, Emin Murat Akbas, Rıfkı Ucler, Tevfik Sabuncu, Mehmet Ali Eren, Alpaslan Kemal Tuzcu, Zafer Pekkolay, Mesut Ozkaya, Mustafa Araz

Abstract

Introduction: Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians' attitudes to deintensify or intensify treatment.

Methods: Data from older adults (≥ 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of ≥ 2 oral antihyperglycemics or insulin, and BP overtreatment was defined as systolic BP (SBP) < 120 mmHg or diastolic BP (DBP) < 65 mmHg plus the use of ≥ 2 drugs. Undertreatment of glycemia was defined as HbA1c > 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s).

Results: The rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. In the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2-3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0-3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14-3.04). There was no independent association of BP undertreatment to the study confounders. The deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP.

Conclusions: The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM.

Trial registration: ClinicalTrials.gov identifier, NCT03455101.

Keywords: Arterial blood pressure; Glycemia; Older adults; Overtreatment; Type 2 diabetes; Undertreatment.

Figures

Fig. 1
Fig. 1
Patient characteristics independently associated with glycemia overtreatment and undertreatment, respectively. BMI Body mass index, CI confidence interval, OAD oral antidiabetic drug, SU sulfonylureas
Fig. 2
Fig. 2
Patient characteristics independently associated with blood pressure overtreatment and undertreatment, respectively

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